Tutoring runs at the Centre only
Please complete the details of your child wishing to participate in tutoring (a separate form must be filled in for each child).
Child’s full name (Surname and First Name)
Date of Birth:
Parent/Guardian’s Full Name
Parent’s Phone Numbers
Tutoring (Please Tick)
Type of Tutoring required One-to- OneTwo-to-One
No. of Times a Week: Three times a weekFive times a week
Preferred days of the week. (This is subject to availability) MondayTuesdayWednesdayThursdayFriday
Preferred Time: 2-3pm3-4pm4-5pm5-6pm
Booster Classes (Please Tick)
Types of Booster Classes Comprehension Booster ClassMemory Booster Class One-to- OneTouch Typing
Total No. of Sessions ((Minimum of 10 Sessions ):
The name given above will be used as the main form of contact, however, in case of an emergency please can you provide a second contact name and number.
Emergency Contact’s Full Name :
Emergency Contact’s Telephone Number(s):
Does your child have any medical conditions we should be aware of? For example, asthma, epilepsy etc. If so, please give details.
Terms and Conditions
I agree for my child to receive tutoring at Dyslexia Nigeria.
It is my responsibility to arrange the transport of my child to and from their tutoring session.
I agree to respect my allotted time and to ensure my child arrives and leaves promptly for their sessions.
I agree to inform Dyslexia Nigeria of any changes to the information above.
All tutoring takes place in Dyslexia Nigeria Centre Mon-Fri, 2-6pm.
I accept that Dyslexia Nigeria does not endorse and cannot take responsibility for anything which may happen during sessions arranged for other times or outside of the approved Dyslexia Nigeria Centre.
I agree to photos being taken of my child as a record of the sessions and for use in funding applications, future publicity and on the DN website.
Dyslexia Nigeria is a registered organisation established to educate, convene and empower all stakeholders involved with dyslexia in Nigeria to create an environment where dyslexics can thrive.
Address: 1A Akanbi Disu Street off Omorire Johnson off Admiralty way, Lekki Phase 1, Lagos
Call: +234(0)17140015, +234(0)8107531682, +234(0)9025446486
Email Us: firstname.lastname@example.org
Enter your email address
© 2021 Dyslexia Nigeria.
Website by Bowerbird NG
A: 1A Akanbi Disu Street off Omorire Johnson off Admiralty Way, Lekki Phase 1
© 2020 Dyslexia Nigeria.